Contrary to current practice, HIV infection should no longer be considered an absolute contraindication to liver transplantation, according to an article published in the November 15 issue of The Journal of Infectious Diseases. Results of a recent multicenter study show that survival in HIV-positive transplant recipients was similar to that found in contemporaneous age- and race-matched HIV-negative recipients. These preliminary findings provide new hope for many HIV-infected patients who might otherwise die of end-stage liver disease.

With the advent of improved combined-drug treatment, particularly highly active antiretroviral therapies (HAART) in the mid-1990s, immune system function has been improved in HIV-infected patients and survival prolonged. But the incidence of liver failure in such patients has grown, especially among those coinfected with hepatitis C or hepatitis B viruses. Liver transplantation in patients with HIV infection invariably failed in the pre-HAART era because of opportunistic infection or graft rejection. The question was: Would HAART change the prospects for organ transplantation in HIV infection?

The study, reported by Margaret V. Ragni and coworkers at the University of Pittsburgh, the University of Miami, the University of California, San Francisco, King's College, London, and the University of Minnesota, involved 24 subjects with HIV infection and end-stage liver disease (due to hepatitis C in 15 and hepatitis B in 7) who were prospectively followed after orthotopic liver transplantation. All but two had had antiretroviral therapy preoperatively, and all but one were treated postoperatively.

The results: After a mean follow-up of 17 months, the cumulative 12-month survival was 87.1% in the HIV-infected transplant recipients, compared with 86.6% among 5,225 HIV-negative transplant recipients of comparable age, race, and date of transplantation, as recorded in a national liver transplant registry. The probabilit
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Contact: Diana Olson
dolson@idsociety.org
703-299-0201
Infectious Diseases Society of America
13-Nov-2003

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